The growing concentration of abortion among women with incomes below the federal poverty line likely reflects a combination of factors. Between 2000 and 2008, the proportion of women in the overall population who were poor increased by 25%. And a Guttmacher study published in the Fall of 2009 showed that the deep economic recession may also have played a role, as financial concerns led more women to want to delay childbearing or limit the number of children they have. Meanwhile, abortion service providers and nonprofit abortion funds across the country have sought to meet the growing need among poor and low-income women by providing services on sliding fee scales and by subsidizing abortion services through charitable donations, which may have allowed some poor women to access services they might not have otherwise been able to afford.

“Gaps in unintended pregnancy and abortion between poor and more affluent women have been increasing since the mid-1990s, so—sadly—none of this comes as a surprise,” says Sharon L. Camp, president and CEO of the Guttmacher Institute. “Reproductive health disparities, and health disparities more generally, are endemic in this country and stem from broader, persistent economic and social inequities. We need to bridge these reproductive health gaps by ensuring that all women, regardless of their economic circumstances, have meaningful access to the full spectrum of information and services—both contraceptive services to reduce levels of unintended pregnancy and abortion services.”

Aside from poverty, little changed in the profile of women obtaining abortions between 2000 and 2008. A broad cross section of U.S. women have abortions: Fifty-eight percent of abortion patients in 2008 were in their 20s; 45% were never-married and not living with a partner; 61% were already mothers; 42% were living below the federal poverty line; 36% were white; 59% had at least some college education; and 73% were religiously affiliated. But certain groups of women—those who were in their 20s, cohabiting, black or poor—were overrepresented among abortion patients.

For the first time, the survey on which this report is based asked abortion patients about their health insurance status and how they paid for abortion services. Results showed that these women were fairly evenly divided among those with private insurance (30%), those with no insurance (33%) and those covered by Medicaid (31%). Although a majority had some type of public or private health insurance, it is not clear how many of those plans actually included abortion coverage or had a high deductible that discouraged its use for coverage of abortion.

Fifty-seven percent of all women obtaining abortions reported that they paid out of pocket for the procedure, while 12% used private insurance. (Among those with private insurance, nearly two-thirds paid out of pocket, and about one-third used their insurance.) Twenty percent of women relied on Medicaid; almost all of these women lived in the few states that use their own funds to pay for abortions. Among women on Medicaid who lived in states that use their own funds to pay for abortions, more than nine in 10 relied on this method to pay for their abortion. Some 13% of abortion patients relied on financial assistance programs to cover at least some of the cost of the procedure.

About the Survey

This report is based on a nationally representative survey of women obtaining abortions in the United States. While the data permitted the researchers to calculate the proportion of women obtaining abortions in each socioeconomic category, it did not provide the number or rate of abortions in the United States. The Guttmacher Institute’s Abortion Provider Census is currently in the field; results of that survey will provide information needed for calculating abortion numbers and rates in 2011.